Change Healthcare Holdings, Inc.

What Change Healthcare Holdings, Inc. does

Change Healthcare Holdings, Inc. operates as a healthcare technology and analytics platform within the Optum portfolio of UnitedHealth Group following its 2022 acquisition. Its product set spans revenue cycle management (Optum Integrity One, Claims Automated Rules Engine), clinical decision support (InterQual, ASAM Criteria Navigator, CareSelect Imaging), enterprise imaging (Stratus Imaging PACS), pharmacy benefit management (Optum Rx, Optum Specialty Pharmacy, Optum Infusion Pharmacy), and AI-powered surgical analytics (Crimson AI). The underlying technology is built on advanced data analytics, machine learning, natural language processing, and cloud-native architecture, drawing on one of the largest healthcare data assets in the industry — billions of unstructured medical notes and more than 2,500 diagnostic metrics feeding thousands of AI use cases for predictive, generative, and agentic AI applications.

The company serves five core customer verticals: health plans (8 of 10 U.S. health plans), healthcare providers (8 of 10 U.S. hospitals), employers (8 of 10 Fortune 100 companies), government health programs (federal agencies in 50 states and 20 state Medicaid agencies), and life sciences organizations (140 customers including pharmaceutical manufacturers). Distribution runs through dedicated enterprise sales teams, broker and consultant networks, and digital self-service portals (Optum Pro Portal, Optum Pay, OptumRx PBM).

Revenue derives from a mix of recurring software and platform subscriptions for healthcare technology and analytics services, professional services for revenue cycle management and consulting, and managed services for government healthcare programs. Pricing is quote-based and not publicly disclosed, with the company holding industry accreditations from NCQA, URAC, NABP, and ACHC that underpin eligibility for regulated healthcare contracts. Multiple international offices in Brazil, India, Ireland, and the United Kingdom support global delivery and analytics operations.

Name

Change Healthcare Holdings, Inc.

Legal name

Optum, Inc.

Website

https://changehealthcare.com

Company type

Private

Founded year

2006

Operating status

Operating

Short description

Change Healthcare Holdings, Inc. operates a healthcare technology and analytics platform within Optum/UnitedHealth Group, delivering AI-powered revenue cycle management, clinical decision support, enterprise imaging, and pharmacy benefit management to 8 of 10 U.S. health plans, 8 of 10 hospitals, and Fortune 100 employers.

Ownership category

akta.pro rank

Product category

Healthcare Technology and Analytics

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Direct Health and Medical Insurance Carriers (524114), Health and Welfare Funds (525120)

SIC

Services-Health Services (8000), Services-Misc Health & Allied Services, Nec (8090), Hospital & Medical Service Plans (6324)

akta.pro primary industry

Care Coordination, Referral Management & Transitions-of-Care Pathways (HLACAGAL)

akta.pro secondary industries

Order Sets, Care Plans & Clinical Pathways (CPOE-integrated) (HLACAGAC), Medication Reconciliation & Transitions-of-Care Pharmacy Services (HLAFALAK), Group Pharmacy Benefit (Rx) Coverage & PBM-Integrated Plans (FSAIAFAN)

Keywords

• Healthcare analytics
• Pharmacy benefit management
• Revenue cycle management
• Clinical decision support
• Healthcare technology services

Headquarters

HQ city

Nashville

HQ country

United States

HQ region

North America

Offices5 records

Markets served

GTM type

B2B

Offering type

Software

Cost components

Personnel, Technology or R&D, Operations, Marketing or Sales, Infrastructure

Revenue model

1. Healthcare Technology and Analytics Services: Provides data analytics, AI-powered solutions, and healthcare technology platforms to health plans, providers, employers, and government agencies. Revenue derived from software licensing, platform subscriptions, and analytics service fees.
2. Pharmacy Benefit Management (PBM): End-to-end pharmacy benefit management including formulary management, drug trend prediction, prior authorization, and specialty pharmacy services for health plans and employers.
3. Revenue Cycle Management Services: RCM services including claims processing, payment integrity, coding automation, and accounts receivable recovery for health systems and providers.
4. Consulting Services: Healthcare consulting including strategy, transformation, clinical documentation improvement, and operational advisory services for payers and providers.
5. Government Healthcare Programs: Medicaid, Medicare, federal government, and military/Veteran health program services including eligibility enrollment, fraud prevention, and care coordination.

Go-to-market motion3 records

Distribution channels6 records

Marketing channels10 records

Core offering

Change Healthcare Holdings operates within Optum, delivering an integrated healthcare technology platform that combines data analytics, AI/ML, and clinical expertise for payers, providers, employers, government agencies, and life sciences organizations. The platform spans pharmacy benefit management, revenue cycle management, clinical decision support, imaging solutions, and population health management. The Change Healthcare product line is offered within this Optum portfolio alongside Optum's broader healthcare technology stack.

Product overview

Optum offers a comprehensive healthcare technology platform consisting of a unified product portfolio across pharmacy benefit management, revenue cycle management, clinical decision support, imaging solutions, and population health management. The core offerings include Optum Rx (PBM platform), Optum Integrity One (autonomous RCM), InterQual and ASAM Criteria (clinical decision support tools), Crimson AI (surgical analytics), Stratus Imaging PACS (cloud imaging), CareSelect Imaging (decision support), Optum HouseCalls (assessments), and various specialty pharmacy and care management programs. These products integrate AI and analytics capabilities across the healthcare ecosystem to serve payers, providers, employers, government agencies, and life sciences organizations.

Differentiator

Problem solved

Functional benefit

Products and services

• Optum Rx Pharmacy benefit management (PBM) platform providing formulary management, drug pricing, pharmacy network access, and mail-order pharmacy services to drive better health outcomes and lower costs for plan sponsors and members.
• Optum Integrity One Autonomous-first revenue cycle management platform that modernizes the middle revenue cycle through AI to automate routine tasks, escalate complex issues, and drive results at scale.
• InterQual Clinical decision support criteria used by payers and providers for utilization management, medical necessity reviews, and healthcare quality assessment.
• ASAM Criteria Navigator Evidence-based clinical practice guidelines tool for substance use disorder care, helping payers and providers navigate the complex SUD treatment landscape.
• Crimson AI AI-powered surgical analytics and cost management platform that provides game-style strategies for reducing surgical cost variance and standardizing supply use.
• Stratus Imaging PACS Cloud-native picture archiving and communication system (PACS) for enterprise medical imaging that provides secure image storage, access, and workflow management with dynamic load balancing.
• CareSelect Imaging Imaging decision support solution that helps providers enhance clinical decision-making, improve patient outcomes, and reduce administrative burden through evidence-based criteria.
• Optum HouseCalls In-home and virtual health assessment program for Medicare Advantage members that identifies gaps in care and supports better care coordination.
• Claims Automated Rules Engine (CARE) AI-powered claims processing automation that speeds up the claims process and reduces errors through intelligent rules-based processing.
• Optum Specialty Pharmacy Specialty pharmacy services providing high-touch support for patients on complex medications, including prior authorization assistance and patient support programs.
• Optum Infusion Pharmacy Accredited infusion pharmacy providing at-home and alternate-site infusion care with specialized nursing support for acute and complex conditions.
• Symmetry Oncology Analytics Analytics tools to measure the cost and quality of cancer care, helping payers and providers evaluate oncology treatment effectiveness and spending.
• Optum Frontier Therapies Specialized care program for patients navigating rare and frontier diseases, providing personalized, patient-centered support and treatment management.
• Health Equity Alignment Solution (HEALS) Data analytics solution that identifies where and how health inequities occur within a community, state, or health plan's member population.
• Optum Precision Script Pharmacogenomics integration platform that incorporates genetic data into pharmacy claims to support safer prescribing and smarter medication management.
• DME Navigator Digital solution for streamlining durable medical equipment benefits management, enhancing efficiency and transparency for health plans, clinicians, and members.
• Optum Financial Healthcare payment delivery platform that streamlines operations through digital payment processing, ACH payments, and electronic transaction management.

Quantifiable outcome

• 8 out of 10 health plans served in the U.S.
• +7 more outcomes

Named customers14 records

Segments6 records

Ideal customer profiles6 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability10 records

Feature11 records

Partnerships

Five partnerships are on record, tiered core and supporting.

• IlluminacoreStrategic or Co-development PartnerOptum and Illumina are working together to help patients with genetic testing for rare diseases through advancing clinical access to whole genome sequencing. This partnership leverages real-world data and clinical expertise to improve genetic testing outcomes.
• AlmacoreStrategic or Co-development PartnerAlma partnered with Optum to offer frictionless patient access to mental health care through digital-first channels. This partnership expands behavioral health access for members through online scheduling integration.
• PalmettosupportingStrategic or Co-development PartnerOptum and Palmetto experts partner in discussing how to solve genetic lab challenges in legacy solutions. The partnership focuses on value-based care and genetic testing optimization.
• Advisory BoardcoreStrategic or Co-development PartnerAdvisory Board experts describe types of nonclinical partners and vendors, their benefits and use cases. Optum Advisory provides healthcare consulting and strategic guidance using Advisory Board research.
• Fusion HillsupportingStrategic or Co-development PartnerOptum Serve and Fusion Hill explored the lived healthcare experiences of Veterans, military service members, and their families to understand macro trends shaping military and Veteran care.

Scale indicators11 records

Recent moves6 records

Expansion highlights6 records

Regional players

• HCA Healthcare: Largest U.S. for-profit hospital operator and a significant customer of Optum's RCM and clinical decision support products. While not a direct services competitor, HCA is a key comparable for hospital-side scale and procurement leverage on revenue cycle technology.

Direct peers

• Humana: Major Medicare Advantage-focused payer with a growing CenterWell pharmacy and primary care platform. Competes with Optum in MA risk adjustment, value-based care delivery, and pharmacy services for government program members.
• Centene Corporation: Largest Medicaid managed-care organization in the U.S.; competes directly with Optum in state Medicaid contracts, care coordination for high-need populations, and analytics platforms for government health programs.
• The Cigna Group (Evernorth Health Services): Evernorth is Cigna's health services arm that includes Express Scripts (top-3 PBM), Accredo specialty pharmacy, and pharmacy/clinical analytics. Operates an integrated PBM + specialty pharmacy + analytics portfolio that closely mirrors Optum Rx's positioning.
• Elevance Health (Carelon): Carelon is Elevance Health's health services platform offering PBM (CarelonRx), care management, behavioral health, and advanced analytics — directly competing with Optum across payers and increasingly in PBM and clinical decision support.
• CVS Health (Caremark + Aetna): The closest direct peer: CVS Health operates Caremark (a top-3 U.S. PBM), Aetna (health insurance), and retail pharmacy/clinic assets. Directly comparable PBM scale, health plan membership, and integrated payer-PBM-provider model make it the most relevant peer for Optum.

Broad incumbents

• UnitedHealth Group: The parent company of Optum; operates UnitedHealthcare (largest U.S. health insurer by membership) and is the broadest incumbent across payer, PBM (Optum Rx), provider (Optum Health), and analytics — setting the benchmark for scale in every segment where Optum competes.

Emerging players

• McKesson: Through CoverMyMeds, RelayHealth, and prescription technology solutions, McKesson competes in pharmacy workflow, prior authorization, and biopharma services — overlapping with Optum's pharmacy technology and specialty pharmacy offerings.
• Cotiviti: Specialized healthcare payment integrity, RCM analytics, and risk adjustment vendor that competes directly with Optum Integrity One and CARE claims automation. Comparable niche scale in payment accuracy and provider-facing analytics.
• Walgreens Boots Alliance (VillageMD): Operates a retail pharmacy footprint, specialty pharmacy (via Shields), and primary care clinics (VillageMD). While still scaling its integrated model, it competes with Optum on retail/specialty pharmacy distribution and value-based primary care.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/optum
• Facebookfacebook.com/myOptum
• LinkedInlinkedin.com/company/optum
• Instagraminstagram.com/optum/?hl=en

Compliance6 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Change Healthcare Holdings, Inc.